Rules for the ER (long)

[EDValerieRN]

The Emergency Room

1. The world of ER does not revolve around you. There are sick people here, and you aren't one of them.

2. Our definition of sick is not your definition of sick. If a member of the ER staff says that someone is sick, it means that they are in the process of DYING. They have had a massive stroke, are bleeding out, having a heart attack, or shot. We don't consider a tooth injury sick. Painful, yes. Sick, no.

2. At any given time, one nurse has four patients. One doctor has up to 15. There is a law (similar to Murphy's) in the ER. If you have four patients:

• One of them will be sick (see #2 for definition)
• One of them will be whining constantly
• One of them will be homeless
• and one of them will be the delightful patient.
• Don't be the whiner. Please.

3. Physicians and nurses are not waiters. We are not customer service representatives. This is not McDonalds, and you very well may NOT have it your way. Our job is to save your life, or at least make you feel better. If you want a pillow, two blankets, the lights dimmed, and the TV on channel 14, go to the Ramada.

4. If you have one of the three, go to your own doctor in the morning:

• A cold
• The flu
• A stomach virus

5. If your child has a fever, you had better give him tylenol before coming in. Do NOT let the fever remain high just so I will believe the child has a fever. Do you want your child to have a seizure? Do you?

6. We have priorities. We understand that you have been waiting for two hours in the waiting room. If you don't want to wait, make an appointment with a doctor. The little old lady that just walked in looking OK to you is probably having a massive heart attack. That's why she goes first.

7. Do not ask us how long it will be. We don't know. I don't know what's coming through my door 30 seconds from now... so I surely don't know when you'll be getting a room upstairs.

8. We are not for primary care. Get a family doctor, and go see them.

9. If you have diabetes and do not control it, you are committing slow suicide.

10. We know how many times you've been to an ER. We can usually tell if you are faking it on the first 5 seconds of talking to you. Do not lie to us. If you lie about one thing, we will assume you are lying about everything. You don't want that.

11. If you are well enough to complain about the wait, you are well enough to go home.

12. If your mother is a patient and we ask her a question, let her answer it.

13. If you see someone pushing a big cart down the hall at full speed and you hear bells going off.... do not ask for a cup of coffee. Someone is dying, you inconsiderate %#@^. In the ER, bells don't ring for nothing. Sit down, shut up, and let us work.

14. If you have any sort of stomach pain and you ask for something to eat, you are not that sick.

15. If you can complain about the blood pressure cuff being too tight, or the IV needle hurting, you are not in that much pain.

16. If you want to get something, be nice. I will go out of my way to tick off rude people.

17. Do not talk badly about the other members of staff I work with. The doctor that you hate? I work with him every day, and I know that he knows what he is doing. I trust him a lot more than I trust you. I am not here to be your friend, and neither is he. I will tell him what you said, and we will laugh about it. If you want a buddy, go somewhere else.

18. Every time I ask you a question, I learn more about what is wrong with you. I don't care if I ask you what day it is four different times. Each time I ask, it is for a reason. Just answer the questions, regardless of if you have answered them before.

19. Do not utter the words "It's in my chart." I don't have your chart, and I don't have the time to call and get it. Just tell me.

20. Do not bring your entire posse with you. One person at the bedside is all you need. It is really difficult to get around seven people in the event that you are really sick.

[DebanamRN, MSN, RN]

I'd be willing to settle for a blowgun or a tranquilizer gun from Fish and Game. I'm not picky. I think it would be really cute to watch someone run around the ER for a couple of minutes, like the lions on the savannah do, and then have them collapse in a gentle heap of the floor. Save me a lot of time doing tie downs too.

Last week I told the RN that I wanted to shoot a family member with a thorazine dart. She said I was mean. She then said to go for it. The family member was worse off than the psych patient.:chuckle

[LMPhilbric]

I'm also going to post a rule...it takes 24 hours to die of dehydration and 14 days to die of starvation. You have not been waiting nearly that long, therefore you are not starving nor dying of thirst.

[Natkat, BSN, MSN, RN]

I'm also going to post a rule...it takes 24 hours to die of dehydration and 14 days to die of starvation. You have not been waiting nearly that long, therefore you are not starving nor dying of thirst.

I wish we had that sign when I was in clinicals.

We had a young Mom, about 3 weeks postpartum, high fever, abdominal pain, probable retained placenta or endometritis. Either way, not good. She came in through the ER and while waiting for a bed she started whining about being hungry. They told her she couldn't eat or drink because of the possibility of having to have surgery. Over time the whining got worse until she finally broke out into screams of I'M GONNA STARVE TO DEATH IF I DON'T EEEEEEEEEEEAT!. To make matters worse her thick-headed, no-neck boyfriend was threatening to kick everyone's ass if they didn't give her some food.

Go home.

[ERRNTraveler, RN]

You'll notice it's usually the largest patients complaining of not having any food... I always want to tell them, "um, I think you have plenty of 'reserves' stored up to last you until you can eat again..."

[chicagobsn]

my off topic a lil

I just wanted to say ive been to the ER twice in my life..once was when i was in a horrible car accident, pregnant, tachy, throwing pvcs, SOB, fx pelvis, hip and arm, and pnuemothorax. The ER NURSES & DOCs SAVED MY LIFE.

Second time my 18 month old son was mauled in the face by a random, huge stupid dog. (hes fine now)

ER NURSES & Doc PATCHED HIM UP AND GAVE EXCELLENT CARE

I was an OR nurse for yrs, but 2 wks ago I left to become a ER nurse, because I want to be that person for others...

For all you do, I want to thank u! And this thread has helped me learn a lot, and laugh a lot! Keep it goin!

:redbeathe:nurse:

[robfall]

If you are drunk/high or haven't bathed in weeks; please don't hit on my female coworkers. You'll end up with my male, middle aged self as your nurse.

[Irish-RN]

A friend sent this to me a couple months ago and it had the Nurses and Doctors laughing for days!

Here are some tips to remember before your next visit to the ER

You need to remember these are from some practicing and former Emergency dept.

RNs! The only thing missing is the cultural humor!

1. Don't tell me you have abdominal pain as you eat

Doritos in my triage booth.

2. If you come to the ER by ambulance, the first

thing I will ask you is how you are getting home. No, we

don't have

people on staff to drive you home, and don't tell me

you don't want to "bother" one of your family

members at this hour. You had no problem bothering

911 for the back pain you've had for 3 months.

3. You don't get to pick your own IV site. This

will irritate me and I will probably miss your IV on

purpose and start your site in the place I wanted to

initially to prove a point

4. "Butterfly" is not an IV size, this word signals

me to put in a larger bore needle.

5. Nausea is not a reason to come to the ER. If

you are not in severe pain, are not vomiting or

pooping your pants in front of me, your butt goes

back to the waiting room.

6. How can you have the worst migraine of your

life, but be able to yell at me about the wait after

you just put down a magazine you were reading?

7. Don't ever say things like, "I usually get 4 mg

of Dilaudid". Requesting your med and dosage will

prompt me to squirt out half of the med before I

inject, then I lie about the dose.

8. If you are allergic to Tylenol, Toradol, and

Motrin, I have already assumed you are a drug

seeker.

9. If you came to the ER having a family doctor

appointment that same day, I will make sure you are

still in the department well past the time of your

original appointment.

10. I don't care if you are neighbors with the GI

specialist. Unless he drove you to the ER himself,

you can't be that friendly.

11. Just because, "my doctor sent me here", does

not mean you get right back to a treatment room.

This tells me you are a pain in the ass, and he's

pawning you off.

12. The louder you moan/whine, the bigger size IV

needle you get.

13. Foley catheters cure pseudo-seizures. They

also cure intoxicated persons.

14. If you are on more than 2 medicines at home,

bring a list. Don't say, "you know, the little

white pill". I am not a pharmacist.

15. RN is not synonymous with waiter/waitress.

16. Don't ***** about missing breakfast when I'm on

the ninth hour of my shift and haven't peed yet.

17. What gives you the right to complain about your

sore throat for a week while I have diarrhea from

the antibiotics I've been taking for pneumonia?

18. Broken toes are not an emergency. We'll make

you feel stupid by putting a little piece of tape

down there and kicking you out.

19. I am currently inventing a trapdoor system in

triage to be triggered when you say the word

"toothache".

20. Cover you mouth when you cough/belch. This is

just common courtesy. When you neglect to do this,

I am tempted to bust butt in your room, then close

the door.

21. If you tell me you have fibromyalgia or chronic

fatigue syndrome, know that I'm rolling my eyes and

thinking you're a loser.

22. If you list Haldol, geodon, Xanax, and

trazadone as allergies, don't tell me you have no

psych history.

23. Never sign in with chest pain because you were

too embarrassed to write "penile sores" or "foul

smelling discharge". This will **** me off that I

bumped you ahead of other people and I'll make your

visit horrific.

24. Although you've been in the ER four times this

week, you cannot list the ER doc as your family

physician.

25. Do not talk to me while I'm trying to listen to

your lungs.

26. Don't tell me you have no money for medicine

while you have a carton of cigarettes in your purse

(next to your cell phone), and each of your seven

children are playing their own Nintendo DS.

27. Gravida 7 at age 22 means you are a ****.

--

Nicole R. Hayden RN, BSN

I recently had a patient come in with c/c "sinus" who said they couldn't get in to see their Primary Physician until that afternoon and they "couldn't wait that long." Well, guess what.....you may still be waiting that long.

[canoehead, BSN, RN]

Number 7 is disgraceful. Tempting by times, but totally unethical and will get you in trouble for diversion with the BON, the hospital and the feds. Otherwise...yah, I admit I've toyed with most of these.

[lpnstudentin2010, LPN]

****note I realize this is a vent thread, just wanted to give my point of view****

3. You don't get to pick your own IV site. This

will irritate me and I will probably miss your IV on

purpose and start your site in the place I wanted to

initially to prove a point.

While I do not " pick my site I will tell you where they have luck as I am a hard stick

4. "Butterfly" is not an IV size, this word signals

me to put in a larger bore needle.

As above, I will tell you that they usually need a small gauge needle, I am a hard stick.

[trudlebug]

****note I realize this is a vent thread, just wanted to give my point of view****

While I do not " pick my site I will tell you where they have luck as I am a hard stick

As above, I will tell you that they usually need a small gauge needle, I am a hard stick.

Like I tell my daughter "it's not what you say, but how you say iit" If you TELL me where to start your IV versus saying "most people have luck here" means a world of difference .

[Irish-RN]

Number 7 is disgraceful. Tempting by times, but totally unethical and will get you in trouble for diversion with the BON, the hospital and the feds. Otherwise...yah, I admit I've toyed with most of these.

Relax.....most of the things on the list we only daydream of doing. Helps get us through the day/night. The list is just a fun way of venting our frustrations on paper!

[LPN2RNdude]

The hospital doesn't belong to just you, it belongs to the people...the homeless, the poor...the ignorant and the drug abuser and the alcoholic...the repeat offender...whatever.

i take it you do not work in an ER. if you did, youd see what we are talking about. get a grip.... this is just stress relief. lets see how u feel when youre medicating a drug addict every day of the week, one that lies in your face and treats you like sh*t.